Understanding Total Knee Replacement

February 24, 2022

If you have diseased knee joint(s) and are thinking of getting a total knee replacement, this article might help you with some of the pre operative questions, what to expect from the surgery etc.

When should I consider getting a knee replacement surgery?

  • Knee pain is affects day to day activities

  • Legs and knees joints become deformed

  • There is pain in the knees while walking

  • You have stopped going for morning and or evening walks because of knee pain

  • You need walking aid like stick or walker because of knee pain

  • When you start withdrawing from active social life because of knee pain and apprehension regarding availability of high commode in washrooms or fear of being mocked for abnormal walking, stance or use of walking aids

  • Difficulty in sitting or getting up from the floor, stools or a commode

  • If you feel you knee joints suddenly give way or move on the inside

  • Need for pain killer medications has increased or pain killers are not working anymore

What is knee replacement (TKR)? Where does my old knee go?

Knee replacement (TKR) is actually a misnomer, it should correctly be called a Surface replacement. Because we do not take away your knee and put in an entirely new artificial knee joint. It is like how a tooth capping is done. The damaged portion of the knees is cut in a specific shape and capped with a ceramic or metallic implant, which takes away the pain because of friction between the damaged parts of the knee.

So, after knee joint replacement, your bone stays with you, your muscles and ligaments stay with you. But you have a new metallic surface that has replaced the damaged surface of your knee joint.

Is Knee Replacement Surgery Safe?

Knee joint replacement is one of the most frequently performed surgeries in the western world and has recently gained pace in India also. It is an extremely safe procedure, and innumerable people have undergone it. SNH follows international safety protocols for patients who need this surgery. Patients are investigated before surgery where cardiological assessment is done beforehand and the anesthetist sees the patient before admission. Few investigations are done so that vitals are known, and the position of different organs or presence of any infections in the body is ruled out. 

When all these precautions are taken, it increases the safety of surgery manifold besides instilling confidence in the patient that he/she can undergo the procedure safely.

Who is a fit candidate for knee replacement surgery?

Age is actually not the criteria for surgery. What dictates surgery is the need for it and the ability of one’s body to tolerate surgery. If significantly crippled/disabled, even young may need surgery. There are problems like Rheumatoid arthritis and its various forms and variants that strike patients at young age making their joints painful, deformed and non-functional. So, these patients will also need surgery. Old age carries with it problems like cardiac ailments, previous surgeries, Diabetes, Hypertension etc.

What is needed here is proper preoperative assessment including investigations to assess the risk associated with undergoing surgery. These risks usually cannot be quantified but it helps in deciding if it is safe to go ahead.

Should I get both knees replaced together or one at a time?

If one knee is affected, only one will be replaced and if both knees are affected, then what dictates this decision is the amount of deformity and disability in knees and the patient`s physiological condition. If both knees are significantly deformed, then ideally both should be ideally replaced. But if one is affected more and other mild then one can consider one at a time. If a patient has an underlying condition like cardiovascular problems or any other condition that may jeopardize the patient condition postoperatively, you may be advised to undergo surgery of one knee at a time.

If one knee is replaced at a time, when should I get my 2nd knee replaced?

The usual practice is to replace one knee at first and then the second one on the 3rd or 4th day. This is done in patients with very bad deformities who are unable to walk unless the second side is done. The Ideal time of having the 2nd surgery is between 1.5 to 3 months after the 1st one as it gives sufficient time to the body to recuperate and the 1st knee to become near normal.

Which implant should I choose?

Functionally speaking there is no difference between the implants. The patient will not be able to appreciate the difference among implants after surgery. All implants essentially fare the same with regard to function. Means all that a patient can do with a Oxinium or Gold Implant, he will also do with a Cobalt Chromium implant. What is more important is post operative physiotherapy and diligence in doing exercises, that’s what gives the best results. I recommend standard Cobalt Chromium implants to patients and Gold and Oxinium on demand.

I have an allergy to metal. Does it make a difference?

Metal allergy is a serious problem if detected after surgery. Those patients who develop some kind of reaction or skin eruption on donning earrings, bangles, rings etc and other jewelry need special implants.

Nickel is the most common causative of metal allergy and is present in all Cobalt Chromium alloy implants. So, patients with metal allergy can have two implants; Oxinium with all Poly Tibia or Gold Knee.

I fear surgery. What should I do?

Nobody undergoes surgery by choice but out of need or compulsion. Surgery is usually advised when all other treatment modalities have failed. Consult your doctor and who will counsel you rightly. You can also talk to patients who have successfully undergone the procedure and are living their lives happily. Most patients have a fear of ‘being worse off’ than before. But as previously discussed, this is a very successful surgery, so there is a very minuscule chance of that happening. Patients who undergo surgery usually have a pleasant experience and are of the opinion that they unnecessary delayed surgery, that they should have undergone it earlier and not wasted precious years.

What are the complications after knee replacement (TKR) surgery?

The possible complications are numerous, but the complication rate is less than 0.5% in our hands. That’s a very take-able risk and one need not fear. For the sake of completion, the complications that may be encountered are infection, deep vein thrombosis or clots in the veins, loosening of implant, instability, persistent anterior knee pain; these complications, if detected in time, are treatable.

How long do the implants last?

The knee implants usually last more than 20 years. This also means that some patients who have a knee replacement (TKR) at a relatively younger age may eventually need a second/revision operation later in their life.

What is the Exercise or physiotherapy Protocol after surgery?

On the first day or two after surgery, a physical therapist will help you get out of your hospital bed. You will start to walk using a walker. Daily physiotherapy shall be done in the hospital stay and by discharge, the patients shall be able to walk with a walker or stick in the room and corridor, go to the washroom and climb a few stairs.

After you leave the hospital, you will continue therapy at home or in a physical therapy center for another 2 weeks at least. Duration of therapy is individualized as per patient’s recovery.

When can I resume work?

Generally, you can return back to work four to six weeks post-surgery if you have a desk job. You may be instructed to expect a longer recovery time before you return to a physically demanding job. You may have to wait between four and 12 weeks before you will be allowed to lift heavy objects or engage in physically challenging work.

What are the precautions to be taken after surgery?

  • Use walker/stick support as instructed

  • Avoid falls at home

  • Avoid floor level activities for at least 3 months after surgery

  • Avoid any sort of infections particularly tooth infections and urinary tract infections

  • Inform your surgeon in case you have persistent pain, fever, swelling or any discharge from the operated site

How frequently should I visit my operating surgeon?

Usually patients are recommended to visit their operating surgeon 2-3 weeks after the surgery for stitch removal followed by another visit after 6 weeks. An X-ray shall be performed for evaluation at 6 weeks. You may need another visit at 3 months and then once in a year, maybe.

Do I need any modification at my home to prepare for surgery?

To make your home safer and easier to navigate during recovery, consider doing the following:

  • Install safety bars or a secure handrail in your shower or bath, and at home

  • Arrange for a toilet-seat riser with arms if you have a low toilet

  • Get a stable bench or chair for your shower

  • Remove loose rugs and cords

I am Overweight. Can I undergo surgery?

When knees are arthritic and painful the patients walk less and that too within the house. So they burn less calories, and gain more weight resulting in even less walking. So they get trapped in a vicious cycle where less walking leads to obesity and obesity in turn leads to even less walking. If one is severely overweight (morbid obese), and intends to get bariatric (weight reduction) surgery, then that surgery should be performed before the knee replacement (TKR) as bariatric surgery after knee replacement (TKR) may lead to laxity in knee ligaments and cause problems in some cases.

Mostly what happens is that patients get knee replacement (TKR) done and a few motivated ones lose weight by doing intense workouts, walking and diet modification, but most continue as such and are just happy of being relieved of their knee pain.

It is usually safe for obese people to undergo knee replacement (TKR) unless one has morbid obesity where risk of complications is more.

When can I travel / drive a car or 2 wheeler?

Patients can drive a 4 wheeler usually after 2 weeks of surgery provided their reflexes and muscle strength have returned to their presurgical levels. This duration can vary from patient to patient depending on age, presurgical deformity, pain tolerance, muscle power and duration since surgery. It is generally advised not to drive a 2 wheeler for at least 3 months after surgery.

Does the implant cause any problem in frisking & scanning at airports?

In case of metal plate, screws, metal rod or any other orthopedic implant, a patient may set off the airport metal detector. It is advised to inform the security officer beforehand about the implant and where it is located in your body. You can expect a hand search by hand held metal detector along with the walk-through metal detector. We provide our patients with an ‘Implant Card’ which mentions the make and location of the metal implant and carries a photograph of the patient, date of surgery, and treating doctor with contact details. This helps our patients to travel without any hassle and they can frisk through the airport by showing the card.

We at Sehgal Neo Hospital use minimally invasive methods to treat damaged knee joints, it is painless, with faster recovery, SNH offers state-of-the-art care and personalized #healing experience in Paschim Vihar, New Delhi.

Get second opinion from our expert clinicians, write to us sehgalnh@yahoo.co.in, call us at +91 85275 97171 or 011 4556 5656 to book an appointment. Visit us at www.sehgalneohospital.com to learn more.